What is the appropriate method of pathological specimen collection for cholangiocarcinoma detection in primary sclerosing cholangitis?
- PMID: 38713262
- DOI: 10.1007/s00535-024-02105-y
What is the appropriate method of pathological specimen collection for cholangiocarcinoma detection in primary sclerosing cholangitis?
Abstract
Background: In primary sclerosing cholangitis (PSC), it is important to understand the cholangiographic findings suggestive of malignancy, but it is difficult to determine whether cholangiocarcinoma is present due to modifications caused by inflammation. This study aimed to clarify the appropriate method of pathological specimen collection during endoscopic retrograde cholangiopancreatography for surveillance of PSC.
Methods: A retrospective observational study was performed on 59 patients with PSC. The endpoints were diagnostic performance for benign or malignant on bile cytology and transpapillary bile duct biopsy, cholangiographic findings of biopsied bile ducts, diameters of the strictures and upstream bile ducts, and their differences.
Results: The sensitivity (77.8% vs. 14.3%, P = 0.04), specificity (97.8% vs. 83.0%, P = 0.04), and accuracy (94.5% vs. 74.1%, P = 0.007) were all significantly greater for bile duct biopsy than for bile cytology. All patients with cholangiocarcinoma with bile duct stricture presented with dominant stricture (DS). The diameter of the upstream bile ducts (7.1 (4.2-7.2) mm vs. 2.1 (1.2-4.1) mm, P < 0.001) and the diameter differences (6.6 (3.1-7) mm vs. 1.5 (0.2-3.6) mm, P < 0.001) were significantly greater in the cholangiocarcinoma group than in the noncholangiocarcinoma group with DS. For diameter differences, the optimal cutoff value for the diagnosis of benign or malignant was 5.1 mm (area under the curve = 0.972).
Conclusion: Transpapillary bile duct biopsy should be performed via localized DS with upstream dilation for the detection of cholangiocarcinoma in patients with PSC. Especially when the diameter differences are greater than 5 mm, the development of cholangiocarcinoma should be strongly suspected.
Keywords: Bile cytology; Cholangiocarcinoma detection; Endoscopic retrograde cholangiopancreatography; Primary sclerosing cholangitis; Transpapillary bile duct biopsy.
© 2024. Japanese Society of Gastroenterology.
Similar articles
-
Endoscopic retrograde cholangiopancreatography and intraductal ultrasonography in the diagnosis of autoimmune pancreatitis and IgG4-related sclerosing cholangitis.J Med Ultrason (2001). 2021 Oct;48(4):573-580. doi: 10.1007/s10396-021-01114-1. Epub 2021 Jul 31. J Med Ultrason (2001). 2021. PMID: 34331625 Review.
-
Endoscopic retrograde cholangiopancreatography for primary sclerosing cholangitis.Clin Liver Dis. 2014 Nov;18(4):899-911. doi: 10.1016/j.cld.2014.07.013. Epub 2014 Sep 6. Clin Liver Dis. 2014. PMID: 25438290 Review.
-
Endoscopic transpapillary intraductal ultrasonography and biopsy in the diagnosis of IgG4-related sclerosing cholangitis.J Gastroenterol. 2009;44(11):1147-55. doi: 10.1007/s00535-009-0108-9. Epub 2009 Jul 28. J Gastroenterol. 2009. PMID: 19636664
-
Transpapillary intraductal ultrasound in the evaluation of dominant bile duct stenoses in patients with primary sclerosing cholangitis.Scand J Gastroenterol. 2007 Aug;42(8):1011-7. doi: 10.1080/00365520701206761. Scand J Gastroenterol. 2007. PMID: 17613933
-
Cholangioscopic characterization of dominant bile duct stenoses in patients with primary sclerosing cholangitis.Endoscopy. 2006 Jul;38(7):665-9. doi: 10.1055/s-2006-925257. Epub 2006 Apr 27. Endoscopy. 2006. PMID: 16673310
References
Publication types
MeSH terms
LinkOut - more resources
Full Text Sources
Medical